Diagnosis of Anoxia
Anoxia Diagnosis: Book Excerpts
Diagnostic Tests for Anoxia: Online Medical Books
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HYPOXEMIA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- What is the carbon dioxide level? An increased carbon dioxide level suggests pulmonary emphysema, asthma, pickwickian syndrome, respiratory paralysis, central nervous system disease, kyphoscoliosis, drug effects, and disorders of the chest wall and spine.
- What does spirometry show? If spirometry shows a decreased 1-second timed vital capacity with an increased carbon dioxide level, consider emphysema and asthma likely. If the timed vital capacity is normal, a diagnosis of pickwickian syndrome, respiratory paralysis, central nervous system disease, drug effects, and chest wall and spine disorders should be considered.
- If the carbon dioxide level is normal or decreased, what does the chest radiograph show? A focal infiltrate suggests pulmonary infarct, congestive heart failure, or pneumonia. A diffuse infiltrate or negative chest x-ray suggests congestive heart failure, pulmonary fibrosis, shock, pulmonary or intracardiac shunt, sarcoidosis, pneumoconiosis, or alveolar proteinosis.
- What does a perfusion scan show? If this is positive, consider pulmonary infarction.
- What does the pulmonary capillary wedge pressure show? If this is increased, consider congestive heart failure. If this is decreased, the patient may have hypovolemic shock. If it is normal, consider a right-to-left shunt, pulmonary fibrosis, pneumoconiosis, or sarcoidosis.
DIAGNOSTIC WORKUP
Repeated arterial blood gases should be done. A CBC, urinalysis, chemistry panel, methemoglobin, sulfhemoglobin, carboxyhemoglobin, venous pressure and circulation time, blood volume, serial ECGs, CT scan of the chest, lung biopsy, additional pulmonary function tests, and consultation with a pulmonologist or cardiologist will be necessary in many cases.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
HYPOXEMIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The clinical picture of obstructive lung disease is usually obvious. Other causes of hypoxemia may require more extensive laboratory evaluation to diagnose. Arterial blood gases are the most important study. An increased carbon dioxide will suggest pulmonary emphysema or asthma. Pulmonary function tests can assist in the diagnosis in these conditions as well. If the carbon dioxide level is normal or decreased, a perfusion or defusion defect must be looked for. A lung scan will help rule out a pulmonary embolism. A chest x-ray will help reveal pneumothorax, atelectasis, sarcoidosis, and pulmonary fibrosis. An arm-to-tongue circulation time will help rule out CHF. A consult with a pulmonologist or cardiologist is always wise when faced with hypoxemia.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Acute respiratory failure in COPD:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Progressive deterioration in ABG levels and pH, when compared with the patient’s “normal” values, strongly suggests ARF in COPD. (In patients with essentially normal lung tissue, pH below 7.35 usually indicates ARF, but patients with COPD display an even greater deviation from this normal value, as they do with PaCO2 and PaO2.)
Other supporting findings include:
❑ Bicarbonate — Increased levels indicate metabolic alkalosis or reflect metabolic compensation for chronic respiratory acidosis.
❑ Hematocrit (HCT) and Hb — Abnormally low levels may be due to blood loss, indicating decreased oxygen-carrying capacity. Elevated levels may occur with chronic hypoxemia.
❑ Serum electrolytes — Hypokalemia and hypochloremia may result from diuretic and corticosteroid therapies used to treat ARF.
❑ White blood cell count — Count is elevated if ARF is due to bacterial infection; Gram stain and sputum culture can identify pathogens.
❑ Chest X-ray — findings identify pulmonary pathologic conditions, such as emphysema, atelectasis, lesions, pneumothorax, infiltrates, or effusions.
❑ Electrocardiogram — Arrhythmias commonly suggest cor pulmonale and myocardial hypoxia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Acute respiratory failure in COPD:
Diagnosis
(Handbook of Diseases)
Progressive deterioration in ABG levels and pH, when compared with the patient’s baseline values, strongly suggests ARF in COPD patients. (In patients with essentially normal lung tissue, a pH less than 7.35 usually indicates ARF, but COPD patients display an even greater deviation from this normal value, as they do with blood Paco2 and Pao2.) The following findings further support the diagnosis:
Bicarbonate levels are increased, indicating metabolic alkalosis or metabolic compensation for chronic respiratory acidosis.
Hb levels and hematocrit are abnormally low, which may be due to blood loss, indicating decreased oxygen-carrying capacity.
Serum electrolyte levels may indicate hypokalemia, which may result from compensatory hyperventilation — an attempt to correct alkalosis; hypochloremia is common with metabolic alkalosis.
White blood cell count is elevated if ARF is due to bacterial infection; in certain cases of profound septicemia, the leukocyte count may be decreased. Gram stain and sputum culture can identify pathogens.
Chest X-rays reveal pulmonary pathology, such as emphysema, atelectasis, lesions, pneumothorax, infiltrates, or effusions.
Electrocardiogram reveals arrhythmias, which commonly suggest cor pulmonale and myocardial hypoxia. Large P waves (“p pulmonale”) may indicate a history of right-sided heart failure.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
HYPOXEMIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The clinical picture of obstructive lung disease is usually obvious.
Other causes of hypoxemia may require more extensive laboratory evaluation
to diagnose. It is most important to study the arterial blood gases.
An increased carbon dioxide
level suggests pulmonary emphysema or asthma. Pulmonary function tests can
assist in the diagnosis of these conditions as well. If the carbon dioxide
level is normal or decreased, a perfusion or defusion defect must be looked
for. A lung scan will help rule out a pulmonary embolism. A chest x-ray will
help reveal pneumothorax, atelectasis, sarcoidosis, and pulmonary fibrosis.
An arm-to-tongue circulation time will help rule out CHF. A consult with a
pulmonologist or cardiologist is always wise when faced with hypoxemia.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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